At a Drayton Valley UCP town hall event, Alberta's premier revealed her plans to remove Alberta Health Services (AHS) as the operator of some provincial hospitals and turn those facilities over to other administrators like Covenant Health, a Catholic health care provider.
Alberta Premier Danielle Smith shared the next phases of her government’s restructuring of health care in Alberta on Aug. 17.
The Alberta government is currently setting up a structure where the government retains ownership of facilities and leases them to AHS and is “prepared to also take away their authority to operate hospitals as well,” Smith said.
“Because if our operator isn't performing the services we need them to we're going to take (the hospital) back,” Smith said.
“The next phase is to see how many of those hospitals that AHS currently operates that we can retake ownership over. We can't do it for all of them.”
Smith said this strategy will improve the delivery of health care and help eliminate service disruptions in rural hospitals by introducing two incentives into the existing system — competition and fear.
“When you're dealing with a monopoly, and they believe that they can deliver any type of care, and there are no consequences, they’re going to continue to deliver bad service. And competition is one option. That's why we're offering chartered surgical centres and why we're offering Covenant,” Smith said.
“But the other is the fear of having it taken away. That is going to be a very powerful competitive incentive for the managers to say, ‘Oh my goodness, if we continue to deliver terrible care in Drayton Valley, then somebody else is going to be chosen for the operator.’”
In La Crete, Smith said the government is already moving the hospital authority over to Covenant Health. She told the town hall that Covenant Health “has never closed down rural hospitals . . . and it may well be that we just need different operators in the smaller communities so that we can get back to delivering that level of care.”
These changes will be slow, Smith said, and the government will campaign to get the "authority from Albertans to go forward and make these changes."
Change for the sake of change
Lorian Hardcastle, associate professor in the faculty of law in the Cumming School of Medicine at the University of Calgary, said changing hospital administrators would come with substantial investments of time and money, and that it doesn’t address key issues within the health care system which cause temporary closures.
“It seems to be more of what we've already seen, which is change for the sake of change, and not change with a view to improving access or improving quality,” Hardcastle said.
“AHS has been running these facilities for a long time and has that expertise. For Covenant to take over those facilities is going to take time. It's going to take money. And it's not clear what the payoff is. There may also be some providers who aren't interested in continuing to work at a facility if Covenant takes it over, and so it's not clear that this is going to help recruitment and retention, and it might make it worse.”
Hardcastle said the claim that Covenant Health would be better suited to run rural hospitals is unfounded, and that the premier needs to provide a rationale for why changing operators would have an effect on the number of rural doctors in a community or their availability to work.
“That's just something that she's made up as a theory, and there's no factual support for that. The fact that Covenant hasn't had any ER closures in facilities they run doesn't mean they wouldn't have closures if they ran the same facilities that AHS runs,” she said.
Public notices from Covenant Health show there have been repeated temporary emergency department closures at its hospitals in Bonnyville and Killam due to staffing shortages.
Transferring hospitals to a faith-based operator would also create issues around access to forms of care the facility would not permit to be performed in its facilities, Hardcastle said.
Covenant does not allow staff to provide emergency contraceptives, abortion, medical assistance in dying, and other medical procedures.
Dr. Luanne Metz, Alberta NDP health critic, said the loss of these services in hospitals would create major challenges in rural Alberta.
“It will be devastating for these communities if they lose access to a whole avenue of health care that is provided to other Albertans, and that may be reproductive health care as well as medical assistance in dying, which (Covenant) also does not support,” she said.
Metz said the province’s ongoing health care changes have resulted in budget cuts for AHS that impact the services it needs to provide, while more money is going to restructuring and consultants. The government are the ones “dictating what AHS can do . . . they’re putting all the blame on AHS when, in fact, they’re the ones pulling the puppet strings,” she said.
Talk of changing hospital operators risks adding “another layer of instability” that would make attracting doctors and nurses more difficult and indicates plans for further privatization of the public health system, Metz said.
“I really think that this is part of our move towards privatization. I don't think it's really just a story about Covenant versus AHS. It's a way of introducing the concept of bringing in other providers,” she said.
Metz also challenged the efficacy of existing private health care initiatives in Alberta.
“When (Smith) talks about chartered surgical facilities, they have not helped. We've seen the numbers months ago showing that we're not doing more surgeries. And the whole result of this is also going to make rural health care worse, because it's the most challenging kind of healthcare to provide.”
A spokesperson for the office of the Minister of Health said in an email that the work to refocus Alberta's health care system includes transitioning Alberta Health Services, over time, to deliver only acute care services.
“Both Alberta Health Services and Covenant Health will continue to play key roles in health care service delivery, providing acute care and continuing care services to Albertans. Alberta’s government is committed to ensuring key health partnerships continue, providing Albertans with the best care possible.”
